Predicting the Ideal Implant Size Before Enucleation

Kaltreider, Sara A.; Jacobs, Jeffrey L.; Hughes, Michael O.

doi:10.1097/00002341-199901000-00009

Cited by 48 publications

(25 citation statements)

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“…At least 80% of the volume of an individual's normal globe should be replaced at this point. 4 This means that, for a normal globe, which ranges between 7.0-9.0 ml, 5,6 5.6 to 7.2 ml should be replaced with the orbital implant. A 20 mm and 22 mm porous polyethylene implant measures 4.2 and 5.6 ml, respectively.…”

Section: Discussionmentioning

confidence: 99%

Periumbilical fat auto-graft associated to a porous orbital implant for socket reconstruction after enucleation

Medel

Alonso

Pelaez³

et al. 2016

Orbit

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Having to remove the sclera, fat and the optic nerve in patients undergoing an enucleation, translates in a larger volume that needs to be replaced to achieve good motility and aesthetic results. Using a 20 or 22 mm implant can only partially replace the removed volume. We report the results of our enucleation technique, which includes the use of a porous orbital implant combined with a primary fat graft to replace a higher percentage of the removed volume to achieve a better cosmetic outcome and to avoid implant related complications in high risk patients. Prospective, non-randomized study of enucleated patients for whom porous orbital implantation was performed with anterior placement of a fat auto-graft. The development of implant extrusion or exposure was recorded as well as the presence of conjunctival wound dehiscence and infection. Orbital volume was clinically and radiologically evaluated as well. Twenty-eight patients were included, with a postop follow-up of at least 6 months (6-79 months). No cases of migration or extrusion were found. One case of a large exposure resolved completely. All MRI demonstrated proper implant-graft integration and vascularisation. The aesthetic result and the symmetry were very adequate, with Hertel differences of less than 2 mm in all cases and good motility range. The fat graft is well tolerated, showing low incidence of implant-related complications whilst maintaining good volume and motility.

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Section: Discussionmentioning

confidence: 99%

Periumbilical fat auto-graft associated to a porous orbital implant for socket reconstruction after enucleation

Medel

Alonso

Pelaez³

et al. 2016

Orbit

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“…Large volume deficits are avoided by using the formula Axial Length Ϫ 2 mm to calculate implant size (A-scan ϩ 1 mm ϭ Axial Length, calculation based on A-scan of the contralateral normal eye). 4,5 This formula optimizes volume, prevents superior sulcus deformity and enophthalmos, and provides optimal implant diameter to support the levator muscle.…”

Section: Discussionmentioning

confidence: 99%

“…Adequate implant size is defined in earlier publications. 4,5 Augmentation of the prosthesis by the ocularist produces gratifying results in this subset of patients. If augmentation or other modification of the prosthesis failed to eliminate the ptosis, the patients were considered for surgical treatment of the ptosis.…”

Section: Methodsmentioning

confidence: 99%

“…• Age at the time of enucleation • Number of years of prosthesis wear, manipulation of the eyelids to insert and remove prosthesis • Poor support of the levator by an implant of insufficient diameter or an implant that is displaced from the muscle cone (the percent volume replacement supplied by the implant was calculated by dividing the volume of the implant by the volume of the remaining normal eye 4,5 ) • Depression of the floor of the orbit (blowout fracture) with expansion of the bony orbital volume and downward displacement of the orbital soft tissues • Traumatic or surgical injury of the levator or its innervation before enucleation or secondary implant insertion • Surgical injury to the levator or its innervation during enucleation or secondary implant insertion • An inadequate prosthesis, smaller than that which can be accommodated by the socket • Occult ptosis associated with lower eyelid laxity.…”

Section: Methodsmentioning

confidence: 99%

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Anophthalmic Ptosis: Investigation of the Mechanisms and Statistical Analysis

Kaltreider

Shields²,

Hippeard³

et al. 2003

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The mechanisms producing anophthalmic ptosis should be assessed carefully before surgical repair to achieve optimal aesthetic results. Correction of volume deficiency should be offered before levator surgery for patients with anophthalmic ptosis. The patient should be advised that tilt of the prosthesis is a possible outcome of levator repair and may reflect overcorrection or insufficient volume replacement.

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“…Os métodos indiretos inicialmente utilizavam radiografia e ultra-sonografia e, mais recentemente, a tomografia computadorizada e a ressonância magnética (2)(3)(4) . A tomografia computadorizada é um método que possibilita reconstruções tridimensionais, sendo eficiente para avaliar as estruturas orbitá-rias, principalmente quanto à conformação e dimensões (5)(6)(7)(8) .…”

Section: Introductionunclassified